By MD S.James Zinreich, Donlin M. Long, John K. Niparko, Bert W. O'Malley Jr, S. James Zinrich, Daniel J. Lee
Operative tactics without delay at the base of the mind, internal ear, and cranial nerves are inherently tender undertakings, and are extra advanced by means of the trouble of attaining easy accessibility to this restricted house. that includes large diagrams, illustrations, and images, this ebook comprehensively covers all the valuable surgical ways to the bottom of the cranium. Written via pioneers operating at one of many world's best facilities for complicated neurosurgery, it in actual fact describes the stairs wherein all the key anatomical buildings on the cranium base and internal ear should be accessed on the way to practice complicated surgical interventions.
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Additional resources for Atlas of Skull Base Surgery (The Encyclopedia of Visual Medicine Series)
A small triangular incision with the apex at the cutaneo-vermillion junction or ‘white line’ border of the lip is made to facilitate reapposition of this important aesthetic landmark and to improve the overall cosmetic result of this approach (Figure 6a). A transconjunctival incision is performed posterior to the tarsus in the inferior fornix with transection of the medial and lateral canthal tendons (Figure 6b). The canthal tendons are marked with a silk or nylon suture on the skin flap and the bony site of attachment in the nasolacrimal crest can be marked with a bovie or small drill hole.
Assessment of visual acuity, visual fields, and ocular motility should be routine, with emphasis on detailed examinations in patients with macroadenomas and suprasellar extension. In general, cranial nerves II, III, IV, and VI are not affected until significant parasellar tumor extension occurs. However, acutely expanding or developing lesions, such as hemorrhage within an existing adenoma or infarction (pituitary apoplexy), may also induce palsies of cranial nerves III, IV, and VI and may present as a surgical emergency Slowly expanding tumors or acute changes secondary to intra-tumor Table 1 Regions accessible by the transseptal transsphenoidal approach Sphenoid sinus Pituitary fossa Upper clivus Middle clivus Medial parasella Suprasella Page 53 Figure 1 The various presentations and growth patterns of both pituitary microadenomas and macroadenomas Page 54 Figure 2 (a) Coronal T1-weighted MRI of pituitary tumor with suprasellar extension; (b) coronal T2-weighted MRI of pituitary tumor demonstrating cystic changes.
Ironically, the severity of symptoms in this series of four cases was inversely related to tumor size. (a) Right intracanalicular acoustic neuroma in a patient with severe rotary vertigo; (b) left intracanalicular lesion in a patient with disequilibrium; (c) left-sided acoustic neuroma with cerebellopontine angle extension in a patient with hearing loss; (d) large left-sided acoustic neuroma with brain stem displacement in a patient with hearing loss Page 16 these things, but these complex operations at the base of the brain should not be undertaken by any one individual until all of the knowledge is acquired and all of the skills are mastered.
Atlas of Skull Base Surgery (The Encyclopedia of Visual Medicine Series) by MD S.James Zinreich, Donlin M. Long, John K. Niparko, Bert W. O'Malley Jr, S. James Zinrich, Daniel J. Lee